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Risk of rupture from tubal pregnancy is highest within 48 hours after onset of symptoms

A new study shows that the risk of rupture from tubal pregnancy is highest, at 5 to 7 percent, within 48 hours after onset of symptoms such as abdominal or pelvic pain, vaginal bleeding, and tenderness or mass of the fallopian tubes or ovaries. Once a woman has untreated symptoms beyond 48 hours, there is about a 2.5 percent risk of rupture for every 24-hour period she goes untreated. Treatment usually involves injection of methotrexate and/or surgical incision or removal of the involved fallopian tube. For women with early rupture, their initial warning sign often is the rupture.

Unfortunately, factors important in diagnosing tubal pregnancy are not helpful in predicting the risk of rupture, according to Nina A. Bickell, M.D., M.P.H., of Mount Sinai School of Medicine, and her colleagues. For example, time since last menstrual period, symptoms, physical findings, level of beta-human chorionic gonadotropin (B-hCG, the hormone released at the beginning of pregnancy), and tubal mass size on ultrasound examination were not associated with rupture in a recent study. For the study, the researchers reviewed inpatient, clinic, and physician office charts of 221 women with tubal pregnancy to assess the conditional risk of rupture with time passed since onset of symptoms and other factors related to rupture. The study was supported by the Agency for Healthcare Research and Quality (HS09698).

See "Time and the risk of ruptured tubal pregnancy," by Dr. Bickell, Carol Bodian, Dr.P.H., Rebecca M. Anderson, M.P.H., and Nathan Kase, M.D., in the October 2004 Obstetrics & Gynecology 104(4), pp. 789-794.

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